养老院中经过改良的综合老年评估和定期病例会诊对神经精神症状的短期影响：一项集群随机试验。
The short-term effect of a modified comprehensive geriatric assessment and regularly case conferencing on neuropsychiatric symptoms in nursing homes: a cluster randomized trial.
机构信息
Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Norwegian National Advisory Unit On Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
出版信息
BMC Geriatr. 2022 Apr 11;22(1):316. doi: 10.1186/s12877-022-02976-x.
AIMS
To investigate the short-term effect of implementing a modified comprehensive geriatric assessment and regularly case conferencing in nursing homes on neuropsychiatric symptoms.
BACKGROUND
Neuropsychiatric symptoms are common and may persist over time in nursing home residents. Evidence of effective interventions is scarce.
DESIGN
A parallel cluster-randomised controlled trial.
METHODS
The intervention was monthly standardised case conferencing in combination with a modified comprehensive geriatric assessment. The control group received care as usual.
MAIN OUTCOME MEASURE
The total score on the short version of the Neuropsychiatric Inventory (NPI-Q, 12-items).
RESULTS
A total of 309 residents at 34 long-term care wards in 17 nursing homes (unit of randomisation) were included. The intervention care units conducted on average two case conference-meetings (range 1-3), discussing a mean of 4.8 (range 1-8) residents. After 3 months, there were no difference of NPI-Q total score between the intervention (-0.4) and the control group (0.5) (estimated mean difference = -1.0, 95% CI -2.4 to 0.5, p = 0.19). There was a difference in favour of the intervention group on one of the secondary outcome measures, the apathy symptoms (-0.5 95% CI: -0.9 to -0.1, p = 0.03).
CONCLUSION
In this study there were no short-term effect of case conferencing and modified comprehensive geriatric assessments after three months on the total score on neuropsychiatric symptoms. The intervention group had less apathy at 3 months follow-up compared to those receiving care as usual. The findings suggest that a more comprehensive intervention is needed to improve the total Neuropsychiatric symptoms burden and complex symptoms.
TRIAL REGISTRATION
Due to delays in the organisation, the study was registered after study start, i.e. retrospectively in Clinicaltrials.gov # NCT02790372 at https://clinicaltrials.gov/ ; Date of clinical trial registration: 03/06/2016.
目的
调查在养老院实施改良全面老年评估和定期病例会议对神经精神症状的短期影响。
背景
神经精神症状在养老院居民中很常见，并且可能随着时间的推移而持续存在。有效的干预措施的证据很少。
设计
平行聚类随机对照试验。
方法
干预措施是每月进行标准化病例会议，并结合改良全面老年评估。对照组接受常规护理。
主要观察指标
简短版神经精神症状问卷（NPI-Q，12 项）的总分。
结果
共纳入了 17 家养老院 34 个长期护理病房的 309 名居民（随机分组单位）。干预护理单元平均进行了两次病例会议（范围 1-3 次），讨论了平均 4.8 名（范围 1-8 名）居民。3 个月后，干预组（-0.4）和对照组（0.5）的 NPI-Q 总分无差异（估计平均差异= -1.0，95%置信区间-2.4 至 0.5，p=0.19）。在次要结局指标之一，即淡漠症状方面，干预组有优势（-0.5，95%置信区间：-0.9 至-0.1，p=0.03）。
结论
在这项研究中，三个月后，病例会议和改良全面老年评估对神经精神症状的总分没有短期影响。与接受常规护理的患者相比，干预组在 3 个月随访时的淡漠症状更少。研究结果表明，需要更全面的干预措施来改善神经精神症状的总负担和复杂症状。
试验注册
由于组织延迟，该研究在开始后进行了注册，即在 Clinicaltrials.gov#NCT02790372 上进行了回顾性注册；临床试验注册日期：2016 年 6 月 3 日。
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